You can apply the techniques yourself, and also check out other sources, such as Mote Sexuality, by Bernie Zilbergeld, Ph.D., and All about Sex Therapy by Peter R. Kilmann and Katherine H. Mills. Many sex therapists don’t see any harm in trying sex therapy on your own. If you do decide to proceed, be sure you discuss what you want to do, and why, with your partner before beginning. Take things very slowly. Don’t push yourself to do something you feel unready to do. Make sure you have a private, comfortable environment in which to practice your exercises, and set aside special time for this purpose.

If you make progress on your own, congratulations! And don’t let one setback throw you off course. If, however, you eventually decide to seek professional help, don’t feel that your time has been wasted. Because you are so well informed, you may be able to proceed a little faster than someone else. If you do seek out a professional, be sure to share your self-help experiences with the therapist.

Self-help sex therapy requires thought and careful progression. You have to start at the beginning, with communication, and not just jump right into the exercises. Sex therapy is a little like taking a course: You have to put in study time, you have to do your homework, and sometimes a teacher or therapist is not only helpful, but essential. That’s why we think it’s important to emphasize that if your attempt at self-help isn’t satisfying, you shouldn’t necessarily give up on sex therapy itself. An experienced professional may help you overcome the roadblocks to success that you couldn’t overcome on your own.

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It’s important to determine just how much medicine you need, so you should receive several shots at different times, in the doctor’s office. These test runs can tell you if the shots will work for you, and if there are any complications. Sometimes, a man with leaky veins will spill the medicine out of his penis into his bloodstream too quickly, and become dizzy as a result. In rare cases, his heart rate may slow down. This unwanted side effect can be counteracted by medications.

A more serious situation can occur when a shot produces a full, firm erection which will not subside. As we’ve explained, an erection that won’t go down can cause permanent physical damage which could prevent you from ever getting another erection. If an erection ever lasts longer than four hours, contact your doctor immediately. Do not wait until the next day!

The doctor will probably insert another needle, drain out the medication and release the trapped blood. When this relatively rare complication occurs, future doses need to be drastically reduced, and, in some cases, penile shots must be avoided entirely.

Once you determine your dose, make sure the doctor shows you exactly how to position the needle so you inject the drug without injuring any of the vital nerves which run along the top of the penis. After the injection, you need to apply some pressure to stop the bleeding. And doctors recommend that you massage the penis gently to distribute the medicine.

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Suction or vacuum devices work by creating a vacuum around the penis that sucks blood into it. There are basically two types. After obtaining an erection with one type, the Erecaid System, available only with a doctor’s prescription, a man slips a constricting band similar to a cock ring on the base of the penis to hold the blood in the organ, and removes the suction device.

(Some men have reasoned that they’ll save money and use their vacuum cleaners to produce erections—with absolutely disastrous results. Vacuum cleaners are designed to clean floors and furniture, not to make your penis erect. These machines can literally strip the skin off your penis and cause permanent and serious injury. So don’t even consider using a vacuum cleaner.)

Because the suction devices work by pulling blood into the penis and then trapping it there, a man who can’t get an erection using a cock ring alone may find the suction apparatus does work for him. However, some men do find these devices uncomfortable to use.

You’ve got to be careful with these devices. If you pump one up too energetically, you can bruise your penis, in much the same way that you can give yourself a “hickey” by sucking on your arm. The biggest danger is leaving the constricting ring on too long and constricting the blood flow to the penis, because gangrene can result.

Again, as with a cock ring, if s extremely important that a user not leave the ring on longer than 30 minutes.

After using such an apparatus, some men may find it somewhat uncomfortable to ejaculate. This is because the ring constricts the penis, making it difficult for semen to get out.

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Bladder Surgery

Surgery for advanced bladder cancer requires removal of the bladder and the prostate. New nerve-sparing techniques can help prevent erection problems. Early tumors can also be treated by limited surgery performed through the urethra. This surgery will not affect potency.

Rectal Surgery

Rectal surgery for cancer is similar to radical prostate surgery in that crucial nerves may be injured. Unfortunately the nerves essential for erection are just too close to the rectum to allow for nerve-sparing techniques. Surgery on the rectum for non-malignant disease, however, can be modified so that the nerves are preserved and the ability to get an erection is maintained.

Penile Surgery

The good news about surgery on the penis is that it’s rare. It’s usually performed when a patient has cancer of the penis (a disease which strikes very few men) or for a very severe case of Peyronie’s disease, discussed earlier. It is not true that all penile surgery inevitably leads to lack of erection. Crucial blood vessels or nerves must be damaged for this to happen.

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“It provokes the desire, but it takes away the performance. Therefore much drink may be said to be an equivocator with lechery.” (Macbeth, 2.3.28.)

If only William knew what Will Shakespeare knew: Alcohol can cause erection problems. Alcohol is a drug. In very small quantities it may stimulate arousal, but that’s not the same thing as promoting erection. Far from it. Ultimately, alcohol is a depressant. It slows down reflexes and decreases all sensation, including sexual pleasure. Researchers have confirmed Shakespeare’s assertion that liquor can cause temporary loss of potency. It can also reduce pleasure and, in some men, result in even less intense orgasms.

While a rare binge will not permanently affect potency, long-term abuse of alcohol can wreak havoc on a man’s ability to get and maintain an erection, even when he is not drinking. And in some cases this physical loss can be permanent if it’s allowed to go untreated.

Often, alcoholics don’t come for treatment of impotence until they’re on the wagon. Once on the road to recovery, the alcoholic man may find that his potency has not returned. Roger, for example, a 50-year-old accountant, visited a clinic complaining of a potency problem. A widower for many years, Roger was now living with a woman he hoped to marry. He wanted his new relationship to work, but his sexual problems were causing a strain.

Many alcoholic patients don’t volunteer information about their drinking habits, but Roger was rather direct about his past habits, his medical history and the details of his erection problems. He had been drinking very heavily for more than a decade and he had been a recovering alcoholic and “dry” for two years. Over the last decade, he noticed his erections getting softer. Sometimes he was incapable of getting an erection, no matter how aroused he felt.

Combining Alcohol and Medication

Coming back to our friend William, it’s important to note that he was combining alcohol with his high blood pressure medication. It’s possible that either alcohol or the drug alone would not cause erection problems. But the combination is powerful and may have been too much for his system to take.

In general, anytime you combine alcohol and medication you’re setting yourself up for a potential health problem—which may or may not affect your sexual potency. Before you add hard liquor, wine or beer to your body chemistry, ask your doctor or pharmacist: What are the possible side effects if I drink while taking this medication? Could the combination of alcohol with this drug affect potency?

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